ENDOSCOPIC THERAPY OF SCLEROSING CHOLANGITIS

The efficacy of endoscopic treatment in primary sclerosing cholangitis has not been clearly established, This report presents endoscopic int ervention in 53 consecutive patients with this disorder. Pertinent dat a were abstracted from the GI-TRAC database, medical records, and chol angiograms, and clinical follow-up was obtained by telephone interview of the subjects. Assessed treatment outcomes were clinical symptom, l iver function test, and cholangiographic appearance. Between 1986 and 1993, 85 patients with primary sclerosing cholangitis underwent succes sful ERCP, of which 36 men and 17 women under-went 100 therapeutic end oscopic procedures. Forty-three of 50 dilations, 37 of 38 stentings, 8 of 8 nasobiliary tube placements, and 11 of 17 stone extractions were technically successful. These treatments were complicated by cholangi tis or pancreatitis in 15 patients. Clinical follow-up was obtained in 50 of 53 patients who had undergone 85 procedures (median follow-up o f 31 months): 28 patients felt better, 21 felt the same, and 1 felt wo rse, Liver function tests obtained within 3 months of the endoscopic t reatment were significantly improved compared with pretreatment values (P < .001). Cholangiograms showed improvement in 36% of the patients, no change in 51%, and the effect of therapy could not be assessed in 13%, Overall, 41 of 53 patients (77%) had improvements of their clinic al symptoms, liver function tests, or cholangiograms.